Currently, Fletcher Allen Health Care offers two types of bariatric surgeries:

• Gastric Bypass Surgery (both open and laparoscopic)
• Lap-Band Surgery (laparoscopic adjustable gastric banding)

 
GASTRIC BYSPASS SURGERY

Gastric bypass surgery makes the stomach smaller and allows food to bypass part of the small intestine. You will feel full more quickly, which reduces the amount of food you eat and thus you consume. Bypassing part of the intestine also results in decreased calorie absorption. This leads to weight loss.

The most common gastric bypass surgery is a Roux-en-Y gastric bypass. The Roux-en-y gastric bypass is performed either open (through a single 6-8 inch incision) or laparoscopically (though multiple, smaller ¼- to 1-inch incisions).

The open approach involves an incision to open the abdomen and perform the surgery in open view of the surgical team. The laparoscopic approach creates five or six small incisions instead of the one larger incision. In the laparoscopic approach, a small laparoscope (long, thin metal scope) connected to a video camera, and is inserted through the small abdominal incisions. Once the abdomen is filled with CO2, the laparoscope gives the surgeon a magnified view, on a television screen next to the operating table, of the patient's internal organs. The entire operation is performed "inside" the abdomen, with the instruments being inserted through the various small incisions.

Not all patients are candidates for the laparoscopic approach. Your surgeon will be able to provide you with the most appropriate treatment options for your individual situation.

Advantages of laparoscopic Gastric Bypass, compared with open Gastric Bypass:

• quicker return to work
• decreased postoperative pain
• lower rate of incisional hernia and wound infection

• longer operating time
• higher rate of internal hernia

LAP-BAND SURGERY

A newer technology approved by the FDA in 2001 is the Laparoscopic adjustable gastric band. This is a purely restrictive procedure which involves applying a prosthesis (the Lap-Band) around the stomach—creating a small gastric pouch—and a calibrated opening to the rest of the stomach. Lap-Band surgery is minimally-invasive and limits the amount of food that the stomach can hold at one time. The inflatable balloon on the inside of the band controls the flow of food from this smaller upper pouch to the rest of the digestive tract. The patient will feel comfortably full with a small amount of food thus limiting the amount of calories a patient consumes during a day. The band is adjustable by injecting fluid into a port that is placed below the skin.

• safest and least invasive of the bariatric weight-loss surgeries
• provides good weight loss results with no need to cut or staple the stomach
• band can be adjusted after surgery with no operation to adjust the stoma (the opening between the part of the stomach above the band and below the band)
• fully reversible and removable
• shorter hospital stay, quicker return to work

• provides slower weight loss
• higher overall complication rate, though the complications are better tolerated by the patient and more easily treated than those associated with the gastric bypass.

COMPARISON BETWEEN PROCEDURES

* percent of excess weight loss

** Most Lap-Band complications are better tolerated physiologically by patient. Most are remedied by removing fluid from the band or removing the band laparoscopically.